LCIAD Academy Private Practice Course Module 9: Maintenance and Management of Complications.

• Are your practice terms and conditions very clear as to who is responsible for what during and at the end of treatment?
• Do you have a set protocol for patient recalls and what you look for and document at each visit?
• Are you confident that your results will be maintained for at least 10-15 years?
• Are you ever undecided as to whether to provide a night guard for patients at the end of treatment?
• Do you have problems with patients who complete treatment but never return for checkups or hygiene until they have a problem and then expect you to take responsibility?

The objective of this course is to prepare colleagues for successful private practice.

Whether coming into private practice for the first time as an associate, transitioning from the NHS, setting up a partnership or becoming a principal in your own practice for the first time, planning and organising your first practice and the rest of your career can seem a daunting task. Or maybe it seems simple until you start and the reality is very different from what you envisaged.

This course aims to prepare and educate our colleagues on the scope of modern private practice ownership and cover multiple salient topics that are often overlooked or poorly understood with open discussion, advice, and contributions from well-known guest speakers with extensive experience in assisting colleagues achieve their ideal practice environment.

Your private practice reputation will be built on predictability and longevity of your restorative work which should last many years for your patience if carried out correctly.

Establishing responsibilities for maintenance of advanced dental work must be established clearly from the beginning with the patient, surgeon, restorative dentist, and hygienist or being aware of their respective roles in the upkeep of the final restorative work carried out. It does be very clearly stated what is guaranteed and what is not and your practice’s terms and conditions must be very succinct in defining responsibilities.

Despite the utmost care sometimes dental work does fail within a reasonable period of time and patience will normally fully expect you to rectify the work at no or minimal cost as per your terms and conditions of guarantee.

This module will address management of patients where work has deteriorated after completion of treatment for no immediately discernible reason in a short period of time and are still under the guarantees given by the practice.

It will also cover management of patients who express dissatisfaction with work after completion that is deemed to be technically and biologically correct or patients who have refused to go ahead with recommended work but still wish to come in for examination and hygiene visits and present maintenance problems due to instability of their dental condition.

As well as establishing a sound regular examination and hygiene protocol, this module is to address how to deal with issues such as porcelain chipping, early peri-implant disease, structural failure of a very heavily restored tooth that has been maintained, endodontic failure by new infection or irreversible pulpitis developing on a previously crowned or overlaid tooth.

The Big Picture

Introduction to the course, aims and objectives.
Establishing a practice protocol for ensuring that patients who have had advanced restorative work done and maintained to the highest level.
Understanding that occasionally failures do occur within an unreasonable period of time that need to be rectified by the practice and having clear protocols and guidelines to address these whilst maintaining the patient onside.

The Objectives – What steps are required for excellence in finalisation of restorative work

• Ensuring that the patient is aware that the end of treatment review appointment is the point at which the practice deems treatment have been completed and for the maintenance phase to have started.
• Setting protocols to ensure that the patient and the whole team understand that the end of treatment is actually just the start of maintenance.
• Having a written and clear protocol on the expectations from the patient and team members for their respective responsibility on maintenance of the work carried out and monitoring from the date of the final review appointment.
• Having clear protocols and boundaries for dealing with early failures.
• Having clear team protocols for addressing patients who expressed dissatisfaction or continue to crumble or make unreasonable demands at the end of treatment despite treatment being technically correct.
• Having clear protocols and terms and conditions of responsibility for patients who have refused active treatment for obvious dental problems but wish to continue coming for checkups and hygiene in the knowledge that there are issues that need to be addressed.

The Preparation – how do you prepare the patient for the end of treatment and start of maintenance?

• Establishing a definite baseline from which any guarantees and responsibilities are measured the importance of the end of treatment review appointment.
• Quantifying an exact hygienist protocol that is documented every visit and the method of informing patients if new problems are starting.
• Quantifying the frequency of follow-up radiography.
• Using photographs and intraoral digital scans to monitor structural integrity, wear, changes in occlusion and gradual changes that are not otherwise perceptible.
• Is all of your team aware of your guarantees and able to tell patients exactly what and what is not covered?

The Method – What are your protocols for follow up and maintenance?

• Ensuring that your hygienist/therapist and the clinicians responsible for the treatment are on the same page when it comes to information collection and monitoring and that any advice for the patients to address deterioration is given early.
• Developing a checklist for critical evaluation of all restorative work as if the patient was a new patient at every examination appointment including photographic and/or digital scanner documentation.
• Utilising digital scanning software to highlight changes in occlusion or gingival level that occur over time.
• If you are referring a patient back to a referring dentist, it is important to ensure that you have an end of treatment discharge summary letter to the referring practice specifying the maintenance programme and the records that you will require to sustain guarantees.

Course structure, timetable and content detail

08:30 Registration

9:00 Lecture 1: Dr Koray Feran: Respective responsibilities between a patient, implant surgeon, restorative dentist and hygienist at the end of treatment. Setting maintenance protocols and deciding on occlusal protection.

10:15 Coffee break

10:45 Lecture 2: Dr Koray Feran: Revisiting dental photography digital scanning, periodontal charting and occlusion and functional mandibular envelope to monitor stability long-term.

12:30 Lunch

13:30 Lecture 3: Dr Koray Feran – Addressing short-term failure 1-5 years and protocols and tips for clinical and patient management.

14:45 Coffee break

15:15 Lecture 4: Dr Koray Feran: Dealing with patients who express dissatisfaction with treatment despite everything being technically correct and accepted at the time of fitting. Dealing with patients who make unreasonable demands. Dealing with patients who refuse active treatment but wish to continue coming for checkups and hygiene in the knowledge that there are dental problems that need to be addressed. Allowing “grumble time” and responding reasonably to demanding correspondence.

17:00: Questions

17:30 End

One day of structured didactic teaching by Dr Koray Feran who has 3 decades of experience running a high-end referral practice in London’s W1

This one-day course will provide valuable processes for finalising treatment and establishing clear and well defined criteria for future success, guarantees and responsibilities for long term patient care and stable results.

Password-protected PDF presentations will be shared with all delegates the day before the course.

Course Days:

Day 1 – NSK UK Headquarters, Hertford House, Rutherford Cl, Stevenage SG1 2EF

You do not need to bring anything for this module apart from your laptop.

In the interests of reducing large amounts of printing for environmental reasons and to keep the costs of the course as low as possible, your presentations will be sent to you as a restricted sharing and password-protected PDF document the evening before the course for you to be able to make digital notes as we go.

We strongly advised that you also have a personal subscription to Adobe Acrobat Pro for maximum flexibility with how you interact with your PDF course notes, though in the first instance Adobe Reader which is free of charge will allow access with more limited functionality.

Type of CPD (A,B,C or D) based on GDP Enhanced CPD development outcome requirements

7 hours of CPD

Development outcomes in bold

A
Effective communication with patients, the dental team and others across dentistry, including when obtaining consent, dealing with complaints, and raising concerns when patients are at risk.

B
Effective management of self and effective management of others or effective work with others in the dental team, in the interests of patients, providing constructive leadership where appropriate.

C
Maintenance and development of knowledge and skill within your field(s) of practice.

D
Maintenance of skills, behaviours and attitudes which maintain patient confidence in you and the dental profession and put patients’ interests first.

Brand new course from 2027

Course fees are charged at £795  for dental surgeons.

The course is restricted to 20 dental surgeons.

Lunch and teas / coffees will be served each day and your dietary requirements can be indicated on the accompanying booking form.